Healthcare Provider Details

I. General information

NPI: 1235680471
Provider Name (Legal Business Name): GREGORY BAARTMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1424 E COLLEGE DR SUITE 200
MARSHALL MN
56258-2089
US

IV. Provider business mailing address

1424 E COLLEGE DR SUITE 200
MARSHALL MN
56258-2089
US

V. Phone/Fax

Practice location:
  • Phone: 507-532-2687
  • Fax: 507-337-1054
Mailing address:
  • Phone: 507-532-2687
  • Fax: 507-337-1054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2798
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: